Assistive Reproduction Technology (ART) has been an accepted medical alternative to human reproduction since the first test-tube baby, Louise Brown, was conceived in England in 1978. On the heels of the burgeoning feminist movement of the 1960’s and early 1970’s was borne a new reproductive freedom which has not slowed down since.
However, unlike other research in the medical industry and the research sciences, ART enjoys the privilege of little federal, state, or private industry oversight, with no clear public policy initiatives on the horizon. In fact, the booming In Vitro Fertilization (IVF) industry, making it possible for couples with difficulties either conceiving offspring due to a shortage of healthy egg production, or the inability to carry a baby to full term often due to age, has provided physicians with an endless cash flow.
Supplies of donor eggs guarantees fertility specialists with the commodity or product for an eager and paying clientele with demanding costs between $15,000.00 and $30,000.00 depending on which additional services are utilized in the implantation process. About 15% of insurance providers cover some fertility treatments yet fewer support embryo implantations. However, should a recipient wind up with multiple births as a direct result of multiple implantations, insurance providers wind up picking up the delivery costs.
Yet, what started out to be an alternative in enabling women to become mothers who cannot produce enough healthy eggs has arguably created ethical as well as health concerns with respect to the egg donor business. There are now egg donor brokers who supply eggs to various fertility clinics and there are fertility clinics that have adjunct egg donor programs and storage facilities, eliminating the middleman. But the process of choosing the potential egg donor candidate is one which involves specific criteria and screening in choosing the most suitable donors.
The ideal candidate is recruited through advertisement on the internet, through college newspapers at predominantly Ivy League-type institutions, or local newspapers in college towns. Such ads, which became prevalent in the 1990’s, are placed by fertility clinics or egg brokers with a stated flat fee in compensation and that usually specifies a desired SAT score and desired genetic traits.
Fertility specialists specifically look for women between ages 18-30 who must be earning an undergraduate degree or graduate degree, who are of a certain height and body type and who most likely could use the money. Fees are paid to such women for their time invested in the procedures including medical and psychological testing and time away from school due to appointments and necessary rest. Women are not directly paid for the sale of eggs or human tissue.
The number of paid donors each year is not known but there are approximately 10,000 babies born each year in the United States from donor eggs. Donors receive an average $5,000.00 - $10,000.00 fee per cycle although some receive much more based upon specific desired genetic traits and the recipient’s ability to pay, who is directly responsible for paying the donor. But the questions remain as to whether this process is exploitative to the donors, discriminates against other donors, or is an unhealthy risk to the donor where there is no restriction on the number of times she may donate. Most clinicians restrict donors to a maximum of six times although some have donated more than that.
The donor must go through three weeks of fertility hormone injections and observation in order to create ovarian hyper-stimulation syndrome (OHSS) resulting in a desired over-abundance of eggs producing as many as 10-15 per cycle. This creates many samples from which the physicians may choose for the recipient. Although up to six embryos may eventually be implanted in the recipient the rest are put into frozen storage in liquid nitrogen either for future implantations, donated to other recipients, donated to science, donated specifically for stem-cell research, stored indefinitely or destroyed. Eventually, many will however be destroyed as the costs to store embryos is $3,000.00 – $10,000 each year paid for by the recipient. Presently, there are approximately 500,000 frozen embryos in the U.S.
There is not enough confirmed data on whether egg donors are at heightened risk for potential disease but there is concern of ovarian cancer due to the amount of fertility drugs given donors. And there is concern for the health of donors themselves unable to carry a baby to term should the retrieval procedure go awry. Donors also may suffer hormonal imbalances due to ongoing hyper-stimulation of egg production, especially for those donating multiple times as a result of fertility injections.
There is no direct federal oversight of egg donor programs. However, the Centers for Disease Control and Prevention presides over the screening for disease and genetic testing for diseases and the Federal Drug Administration has jurisdiction over the various fertility drugs used by fertility physicians.
There remains little recourse for those donors who run into complications from such procedures thereafter as donor programs require informed consent. But many clinics are intimidating to unknowing young women many of whom are additionally forced into signing a statement waiving their right to sue the clinic for medical malpractice. However, medical expenses and pain and suffering associated with injurious complications may still be considered medical malpractice caused by negligence. There remains an upside for such clinics contracting with young women not yet quite worldly, their SAT scores notwithstanding, but who do know that they have a large loan to pay back upon completion of their studies.
Most donors must depend on paying for their own health related costs should any arise after the procedure, unless agreed upon prior to the procedure, and for those who do not have their own insurance most clinics insist they purchase it even for the short term. Once involved in such a program there is no guarantee that health information will remain confidential and may impact the donor’s ability to purchase health insurance in the future should there be complications such as infection, internal bleeding, or loss of ovaries. Life insurance could be denied as well should a genetic defect be found during the donor qualifying process.
Not all women are chosen as good candidates for egg donation, however, and go through extensive medical and psychological testing. A donor is required to work with a genetic counselor to provide any known inherited diseases, birth defects, genetic disorders, surgeries or psychiatric problems known to her and those of her family members as well. An adoptee that does not have the medical history of her biological parents is immediately disqualified as a potential donor.
And while blood tests for disease and genetic disorders seem to appear harmless enough to some, participants may regret to learn more than they are ready for about their potential health problems or those of their future children, revealed as a result of the testing. Psychological testing is performed on donors to help ensure the clinic that a donor will fulfill her obligation in the donor program and will not jeopardize her health or the recipient’s chances of becoming pregnant.
And while there are additional genetic procedures for women taking part in IVF such as genetic testing of the embryo prior to its implantation in order to rule out certain diseases, the ability to manipulate embryos specifically for gender selection known as Pre-Implantation Genetic Diagnosis (PGD) started to become popular in the 1990’s, although it origins date back to 1981. Initially, it was available only to recipients of IVF embryo implantation but more and more couples, who are otherwise healthy enough to conceive on their own, are having embryo transplants performed with their own eggs and sperm. The embryo is manipulated outside of the womb in order to guarantee the specific sex of a child. Many do it for “family balancing” or to carry on a family name.
Yet ethical considerations abound with fear of reproducing children with either specific genetic factors or traits and even choosing one sex over another. A proverbial can of worms has been opened with no clear direction by government or the industry itself, which remains self-policed. As it remains a private enterprise, the fertility industry rather prefers it that way, unanswerable to lawmakers or the vast number of insurance companies which deny such coverage.
But what becomes of the participants and the children? Will only those families who can afford thousands and thousands of dollars wind up with “superior” offspring? Will preference for boys in carrying on the family heritage create an imbalanced population as in China and India, where there now is a shortage of girls? And even if IVF costs are reduced, what becomes of those families not choosing artificial means of procreating? Will their offspring who are not the brightest and the prettiest unduly suffer?
From ultrasound, to amniocentesis, to IVF, to embryo transplantation, to genetic testing to gender selection techniques there is a consistent and continuous pattern of scientific ingenuity enhanced by better and more improved technologies. And there is no indication that such momentum is slowing down. As such, speculation exists that it may become possible in the not too distant future for parents to “design” a variety of features of their potential children. But what does this say about ethical standards? How will this impact human behavior? And at what cost will society ultimately pay?
Copyright ©2006 Diane M. Grassi